There has been a discernible tendency in surgery to develop procedures and devices that reduce the need for major surgical incisions which entails extended hospitalization, and increased wound complications such as infections and post operative hernias. These minimally-invasive surgical procedures and devices (i.e., endoscopic and/or laparoscopic surgical procedures and devices) have been especially, but not exclusively, important in abdominal, thoracic, gynecologic, urologic and orthopedic operations. Typically, a scope that is arranged with an external camera and light source, enter the abdominal cavity or joint through two or more small incisions along with one or more surgical instruments. The indicated surgical procedure is then performed by manipulating the long-handled surgical instruments while viewing their actions on a video monitor that receives images of the surgical site from the video camera.
While certain minimally invasive surgical techniques are in practice, there are significant disadvantages which have, to date, limited the applications for these techniques. For example, the standard laparoscopic instruments used in many minimally invasive procedures do not provide the surgeon the ability to mimic open surgical hand dissection techniques. Additionally, manipulation of fragile friable tissues can be difficult and often damaging while manipulating sharp and or small tipped tools inside the body cavity from outside the body. It is often the case that the surgeon would ideally prefer, to actually handle, manipulate, or even dissect a portion of tissue with his or her fingers during surgery, as this activity often provides the most sensitive feedback to the surgeon.
Many minimally invasive techniques are difficult due to the limited access provided to the surgical site, in which tools and viewing scopes are often inserted through narrow cannulae. Some surgeons, therefore, adopt a “hand assisted” approach. To accomplish this approach an incision large enough to accommodate a surgeon's hand is made in the abdomen. The surgeon then views his or her hand dissecting, on a video monitor, enabled by a laparoscope positioned appropriately. Unfortunately most of the time the surgeon's dissecting hand blocks the view of the dissection performed by the fingers. In addition only the operating surgeon can appreciate the course of the operation when the dissection is accomplished by palpation and direct vision is not possible. For certain operations, the hand assisted approach is a link along the learning curve to a laparoscopic approach. Again, with a hand assisted approach, an incision large enough to accommodate a surgeon's hand is created. An incision that is capable of accommodating a surgeons hand renders the procedure conventionally invasive, even though the laparoscope and other instruments are inserted through other small abdominal openings.
A number of devices have been proposed in the prior art that attempt to simulate the manipulative capabilities of a surgeon's finger during surgery. For example, in U.S. Pat. No. 5,522,788, issued to Kuzmak, a blunt laparoscopic dissector device is provided which includes an elongate dissector element including a “finger-like” flexible distal end portion. A cylinder or barrel member disposed at one end of a pair of pivotable control arms provides rotatable mounting of the dissector element. A control assembly, including a control rod connected to the other control arm and extending along the length of the dissector element, exerts a force on the dissector element so as to produce the desired curvature of the flexible distal end portion. A locking mechanism maintains the force on the dissector element so as to maintain the desired curvature. Rotation of the dissector element within the cylinder allows for control of the movement of the device's tip while holding the device in a comfortable stationary position. This device has a “pistol” style handle and forceps-style finger grips. There is no kinesthetic relationship between the tip of the index finger and the tip of the instrument, such that the precise movement of the finger tip is not reflected exactly by the instrument tip. Tactile feedback may be attenuated by the use of concatenated driving and driven elements.
In U.S. Pat. No. 5,810,716, issued to Mukherjee et al., a surgical device is provided for use in minimally invasive surgery that is suited for tele-surgery. The surgical device provides dexterity through articulation of a plurality of concatenated segments that transfer angular rotational motion from a driving device located at its base to the distal end. Each segment in the mechanism acts as both a driven element and a driving element whereby each segment is articulated so that the total articulation of the mechanism is the sum of the articulation motions of each segment. Here again the kinesthetic relationship between the surgeon's fingertip and the tip of the instrument is not exactly reproduced. The tactile feedback needed by the surgeon may be obfuscated by the use of concatenated driving and driven elements.
In U.S. Pat. No. RE38,335, reissued to Aust et al., a surgical device is provided for use in minimally invasive surgery that includes a handle, a first stem section having a longitudinal axis and extending from the handle, and a tissue engaging member for engaging tissue. A second stem section, connected between the first stem section and the tissue engaging member, has a portion which is bendable and supports the tissue engaging member for movement between a plurality of orientations relative to the axis and to the first stem section. The surgical instrument includes a system for bending the bendable portion of the second stem section to change the orientation of the tissue engaging member relative to the axis and to the first stem section from a first orientation to a second orientation. The bendable portion of the second stem section includes a member for enabling bending movement of the bendable portion to locate the tissue engaging member at the same angle relative to the longitudinal axis of the first stem section at more than one location along the length of the bendable portion. However the exact kinesthetic relationship between the surgeon's fingertip and the instrument tip is not possible. Once again the tactile feedback may be filtered by the handle articulation mechanisms.
The foregoing and other prior art devices do not allow a precise kinesthetic relationship between a surgeon's fingertip and the dissecting instrument tip. Those prior art devices may have a limited tactile sensing ability transferred to the surgeon. PCT/US97/11494 teaches a number of surgical instruments which can be mounted directly on a surgeon's fingertip in a way that the surgeon can insert his or her hand into a natural cavity of the patient or through one or more minimal incisions to perform surgical procedures, and also to use his or her fingers to manipulate tissues, thus enabling the surgeon to perform the procedures with the benefits of minimally invasive surgery, but with much greater tactile sense, control, and ease of manipulation. However, these surgical instruments (i) are carried by a finger and operated by the thumb, and are not applicable for procedures in which a single finger is employed for tactile sensing of an intrabody location; (ii) include an operating head which permanently extends far beyond the fingertip on which the surgical instrument is mounted, which limits the tactile sensing for the surgeon; and/or (iii) prevent tactile sensing by the instrument carrying the fingertip altogether.
There is a widely recognized need for, and it would be highly advantageous to have, a finger-like surgical probe devoid of the limitations associated with prior art instruments, and which closely simulates a surgeon's finger, or fingers, so as to enable a surgeon to handle, manipulate, or dissect a portion of tissue through an incision of the type employed during minimally invasive surgical procedures, and maintain a kinesthetic relationship with the surgeon's fingertip.